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Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Comparison of low density and high density pedicle screw instrumentation in Lenke 1 adolescent idiopathic scoliosis

Authors: Mingkui Shen, Honghui Jiang, Ming Luo, Wengang Wang, Ning Li, Lulu Wang, Lei Xia

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

The correlation between implant density and deformity correction has not yet led to a precise conclusion in adolescent idiopathic scoliosis (AIS). The aim of this study was to evaluate the effects of low density (LD) and high density (HD) pedicle screw instrumentation in terms of the clinical, radiological and Scoliosis Research Society (SRS)-22 outcomes in Lenke 1 AIS.

Methods

We retrospectively reviewed 62 consecutive Lenke 1 AIS patients who underwent posterior spinal arthrodesis using all-pedicle screw instrumentation with a minimum follow-up of 24 months. The implant density was defined as the number of screws per spinal level fused. Patients were then divided into two groups according to the average implant density for the entire study. The LD group (n = 28) had fewer than 1.61 screws per level, while the HD group (n = 34) had more than 1.61 screws per level. The radiographs were analysed preoperatively, postoperatively and at final follow-up. The perioperative and SRS-22 outcomes were also assessed. Independent sample t tests were used between the two groups.

Results

Comparisons between the two groups showed no significant differences in the correction of the main thoracic curve and thoracic kyphosis, blood transfusion, hospital stay, and SRS-22 scores. Compared with the HD group, there was a decreased operating time (278.4 vs. 331.0 min, p = 0.004) and decreased blood loss (823.6 vs. 1010.9 ml, p = 0.048), pedicle screws needed (15.1 vs. 19.6, p < 0.001), and implant costs ($10,191.0 vs. $13,577.3, p = 0.003) in the LD group.

Conclusions

Both low density and high density pedicle screw instrumentation achieved satisfactory deformity correction in Lenke 1 AIS patients. However, the operating time and blood loss were reduced, and the implant costs were decreased with the use of low screw density constructs.
Literature
1.
go back to reference Riseborough EJ, Wynne-Davies R. A genetic survey of idiopathic scoliosis in Boston, Massachusetts. J Bone Joint Surg Am. 1973;55(5):974–82.CrossRefPubMed Riseborough EJ, Wynne-Davies R. A genetic survey of idiopathic scoliosis in Boston, Massachusetts. J Bone Joint Surg Am. 1973;55(5):974–82.CrossRefPubMed
2.
go back to reference Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet (London, England). 2008;371(9623):1527–37.CrossRef Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet (London, England). 2008;371(9623):1527–37.CrossRef
3.
go back to reference Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001;83-a(8):–1169, 1181. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001;83-a(8):–1169, 1181.
4.
go back to reference Cheng I, Kim Y, Gupta MC, Bridwell KH, Hurford RK, Lee SS, Theerajunyaporn T, Lenke LG. Apical sublaminar wires versus pedicle screws--which provides better results for surgical correction of adolescent idiopathic scoliosis? Spine. 2005;30(18):2104–12.CrossRefPubMed Cheng I, Kim Y, Gupta MC, Bridwell KH, Hurford RK, Lee SS, Theerajunyaporn T, Lenke LG. Apical sublaminar wires versus pedicle screws--which provides better results for surgical correction of adolescent idiopathic scoliosis? Spine. 2005;30(18):2104–12.CrossRefPubMed
5.
go back to reference Kuklo TR, Potter BK, Jr PD, Lenke LG. Monaxial versus multiaxial thoracic pedicle screws in the correction of adolescent idiopathic scoliosis. Spine. 2005;30(18):2113–20.CrossRefPubMed Kuklo TR, Potter BK, Jr PD, Lenke LG. Monaxial versus multiaxial thoracic pedicle screws in the correction of adolescent idiopathic scoliosis. Spine. 2005;30(18):2113–20.CrossRefPubMed
6.
go back to reference Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine. 2007;32(4):448–52.CrossRefPubMed Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine. 2007;32(4):448–52.CrossRefPubMed
7.
go back to reference Vora V, Crawford A, Babekhir N, Boachie-Adjei O, Lenke L, Peskin M, Charles G, Kim Y. A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine. 2007;32(17):1869–74.CrossRefPubMed Vora V, Crawford A, Babekhir N, Boachie-Adjei O, Lenke L, Peskin M, Charles G, Kim Y. A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine. 2007;32(17):1869–74.CrossRefPubMed
8.
go back to reference Ketenci IE, Yanik HS, Demiroz S, Ulusoy A, Erdem S. Three-dimensional correction in patients with Lenke 1 adolescent idiopathic scoliosis: comparison of consecutive versus interval pedicle screw instrumentation. Spine (Phila Pa 1976). 2016;41(2):134–8.CrossRef Ketenci IE, Yanik HS, Demiroz S, Ulusoy A, Erdem S. Three-dimensional correction in patients with Lenke 1 adolescent idiopathic scoliosis: comparison of consecutive versus interval pedicle screw instrumentation. Spine (Phila Pa 1976). 2016;41(2):134–8.CrossRef
9.
go back to reference Wang F, Xu XM, Lu Y, Wei XZ, Zhu XD, Li M. Comparative analysis of interval, skipped, and key-vertebral pedicle screw strategies for correction in patients with Lenke type 1 adolescent idiopathic scoliosis. Medicine (Baltimore). 2016;95(10):e3021.CrossRef Wang F, Xu XM, Lu Y, Wei XZ, Zhu XD, Li M. Comparative analysis of interval, skipped, and key-vertebral pedicle screw strategies for correction in patients with Lenke type 1 adolescent idiopathic scoliosis. Medicine (Baltimore). 2016;95(10):e3021.CrossRef
10.
go back to reference Clements DH, Betz RR, Newton PO, Rohmiller M, Marks MC, Bastrom T. Correlation of scoliosis curve correction with the number and type of fixation anchors. Spine. 2009;34(20):2147–50.CrossRefPubMed Clements DH, Betz RR, Newton PO, Rohmiller M, Marks MC, Bastrom T. Correlation of scoliosis curve correction with the number and type of fixation anchors. Spine. 2009;34(20):2147–50.CrossRefPubMed
11.
go back to reference Gebhart S, Alton TB, Bompadre V, Krengel WF. Do anchor density or pedicle screw density correlate with short-term outcome measures in adolescent idiopathic scoliosis surgery? Spine. 2014;39(2):E104–10.CrossRefPubMed Gebhart S, Alton TB, Bompadre V, Krengel WF. Do anchor density or pedicle screw density correlate with short-term outcome measures in adolescent idiopathic scoliosis surgery? Spine. 2014;39(2):E104–10.CrossRefPubMed
12.
go back to reference Min K, Sdzuy C, Farshad M. Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up. European Spine J. 2013;22(2):345–54.CrossRef Min K, Sdzuy C, Farshad M. Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up. European Spine J. 2013;22(2):345–54.CrossRef
13.
go back to reference Morr S, Carrer A. Alvarez-Garcia de Quesada LI, Rodriguez-Olaverri JC: skipped versus consecutive pedicle screw constructs for correction of Lenke 1 curves. European Spine J. 2015;24(7):1473–80.CrossRef Morr S, Carrer A. Alvarez-Garcia de Quesada LI, Rodriguez-Olaverri JC: skipped versus consecutive pedicle screw constructs for correction of Lenke 1 curves. European Spine J. 2015;24(7):1473–80.CrossRef
14.
go back to reference Quan GM, Gibson MJ. Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: does higher implant density improve correction? Spine. 2010;35(5):562–7.CrossRefPubMed Quan GM, Gibson MJ. Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: does higher implant density improve correction? Spine. 2010;35(5):562–7.CrossRefPubMed
15.
go back to reference Tsirikos AI, Subramanian AS. Posterior spinal arthrodesis for adolescent idiopathic scoliosis using pedicle screw instrumentation: does a bilateral or unilateral screw technique affect surgical outcome? J Bone Joint Surg Br. 2012;94(12):1670–7.CrossRefPubMed Tsirikos AI, Subramanian AS. Posterior spinal arthrodesis for adolescent idiopathic scoliosis using pedicle screw instrumentation: does a bilateral or unilateral screw technique affect surgical outcome? J Bone Joint Surg Br. 2012;94(12):1670–7.CrossRefPubMed
16.
go back to reference Di Silvestre M, Bakaloudis G, Lolli F, Vommaro F, Martikos K, Parisini P. Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation. Eur Spine J. 2008;17(10):1336–49.CrossRefPubMedPubMedCentral Di Silvestre M, Bakaloudis G, Lolli F, Vommaro F, Martikos K, Parisini P. Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation. Eur Spine J. 2008;17(10):1336–49.CrossRefPubMedPubMedCentral
17.
go back to reference Fu G, Kawakami N, Goto M, Tsuji T, Ohara T, Imagama S. Comparison of vertebral rotation corrected by different techniques and anchors in surgical treatment of adolescent thoracic idiopathic scoliosis. J Spinal Disord Tech. 2009;22(3):182–9.CrossRefPubMed Fu G, Kawakami N, Goto M, Tsuji T, Ohara T, Imagama S. Comparison of vertebral rotation corrected by different techniques and anchors in surgical treatment of adolescent thoracic idiopathic scoliosis. J Spinal Disord Tech. 2009;22(3):182–9.CrossRefPubMed
18.
go back to reference Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2004;29(18):2040–8.CrossRefPubMed Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2004;29(18):2040–8.CrossRefPubMed
19.
go back to reference Suk SI, Kim WJ, Kim JH, Lee SM. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord. 1999;12(6):489–95.CrossRefPubMed Suk SI, Kim WJ, Kim JH, Lee SM. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord. 1999;12(6):489–95.CrossRefPubMed
20.
go back to reference Mac-Thiong JM, Ibrahim S, Parent S, Labelle H. Defining the number and type of fixation anchors for optimal main curve correction in posterior surgery for adolescent idiopathic scoliosis. The spine journal : official journal of the North American Spine Society; 2016. [Epub ahead of print] Mac-Thiong JM, Ibrahim S, Parent S, Labelle H. Defining the number and type of fixation anchors for optimal main curve correction in posterior surgery for adolescent idiopathic scoliosis. The spine journal : official journal of the North American Spine Society; 2016. [Epub ahead of print]
21.
go back to reference Charles YP, Dimeglio A, Canavese F, Daures JP. Skeletal age assessment from the olecranon for idiopathic scoliosis at Risser grade 0. J Bone Joint Surg Am. 2007;89(12):2737–44.CrossRefPubMed Charles YP, Dimeglio A, Canavese F, Daures JP. Skeletal age assessment from the olecranon for idiopathic scoliosis at Risser grade 0. J Bone Joint Surg Am. 2007;89(12):2737–44.CrossRefPubMed
22.
go back to reference Lee SM, Suk SI, Chung ER. Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine. 2004;29(3):343–9.CrossRefPubMed Lee SM, Suk SI, Chung ER. Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine. 2004;29(3):343–9.CrossRefPubMed
23.
go back to reference Li M, Shen Y, Fang X, Ni J, Gu S, Zhu X, Zhang Z. Coronal and sagittal plane correction in patients with Lenke 1 adolescent idiopathic scoliosis: a comparison of consecutive versus interval pedicle screw placement. J Spinal Disord Tech. 2009;22(4):251–6.CrossRefPubMed Li M, Shen Y, Fang X, Ni J, Gu S, Zhu X, Zhang Z. Coronal and sagittal plane correction in patients with Lenke 1 adolescent idiopathic scoliosis: a comparison of consecutive versus interval pedicle screw placement. J Spinal Disord Tech. 2009;22(4):251–6.CrossRefPubMed
24.
go back to reference Kemppainen JW, Morscher MA, Gothard MD, Adamczyk MJ, Ritzman TF. Evaluation of limited screw density pedicle screw constructs in posterior fusions for adolescent idiopathic scoliosis. Spine Deform. 2016;4(1):33–9.CrossRefPubMed Kemppainen JW, Morscher MA, Gothard MD, Adamczyk MJ, Ritzman TF. Evaluation of limited screw density pedicle screw constructs in posterior fusions for adolescent idiopathic scoliosis. Spine Deform. 2016;4(1):33–9.CrossRefPubMed
25.
go back to reference Hosseini P, Nnadi C, Rehak L, Repko M, Grevitt M, Aydinli U, Carl A, Pawelek J, Crandall D, Akbarnia BA. Analysis of segmental mobility following a novel posterior apical short-segment correction for adolescent idiopathic scoliosis. Spine. 2016;41(20):E1223–e1229.CrossRefPubMed Hosseini P, Nnadi C, Rehak L, Repko M, Grevitt M, Aydinli U, Carl A, Pawelek J, Crandall D, Akbarnia BA. Analysis of segmental mobility following a novel posterior apical short-segment correction for adolescent idiopathic scoliosis. Spine. 2016;41(20):E1223–e1229.CrossRefPubMed
26.
go back to reference Wang X, Aubin CE, Robitaille I, Labelle H. Biomechanical comparison of alternative densities of pedicle screws for the treatment of adolescent idiopathic scoliosis. Eur Spine J. 2012;21(6):1082–90.CrossRefPubMed Wang X, Aubin CE, Robitaille I, Labelle H. Biomechanical comparison of alternative densities of pedicle screws for the treatment of adolescent idiopathic scoliosis. Eur Spine J. 2012;21(6):1082–90.CrossRefPubMed
27.
go back to reference Liu H, Li Z, Li S, Zhang K, Yang H, Wang J, Li X, Zheng Z. Main thoracic curve adolescent idiopathic scoliosis: association of higher rod stiffness and concave-side pedicle screw density with improvement in sagittal thoracic kyphosis restoration. Journal Neurosurg Spine. 2015;22(3):259–66.CrossRefPubMed Liu H, Li Z, Li S, Zhang K, Yang H, Wang J, Li X, Zheng Z. Main thoracic curve adolescent idiopathic scoliosis: association of higher rod stiffness and concave-side pedicle screw density with improvement in sagittal thoracic kyphosis restoration. Journal Neurosurg Spine. 2015;22(3):259–66.CrossRefPubMed
28.
go back to reference Sudo H, Abe Y, Kokabu T, Ito M, Abumi K, Ito YM, Iwasaki N. Correlation analysis between change in thoracic kyphosis and multilevel facetectomy and screw density in main thoracic adolescent idiopathic scoliosis surgery. Spine J. 2016;16(9):1049–54.CrossRefPubMed Sudo H, Abe Y, Kokabu T, Ito M, Abumi K, Ito YM, Iwasaki N. Correlation analysis between change in thoracic kyphosis and multilevel facetectomy and screw density in main thoracic adolescent idiopathic scoliosis surgery. Spine J. 2016;16(9):1049–54.CrossRefPubMed
29.
go back to reference Behrbalk E, Uri O, Parks RM, Grevitt MP, Rickert M, Boszczyk BM. Posterior-only correction of Scheuermann kyphosis using pedicle screws: economical optimization through screw density reduction. Eur Spine J. 2014;23(10):2203–10.CrossRefPubMed Behrbalk E, Uri O, Parks RM, Grevitt MP, Rickert M, Boszczyk BM. Posterior-only correction of Scheuermann kyphosis using pedicle screws: economical optimization through screw density reduction. Eur Spine J. 2014;23(10):2203–10.CrossRefPubMed
30.
go back to reference Larson AN, Polly DW Jr, Ackerman SJ, Ledonio CG, Lonner BS, Shah SA, Emans JB, Richards BS 3rd. What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US? J Neurosurg Spine. 2016;24(1):116–23.CrossRefPubMed Larson AN, Polly DW Jr, Ackerman SJ, Ledonio CG, Lonner BS, Shah SA, Emans JB, Richards BS 3rd. What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US? J Neurosurg Spine. 2016;24(1):116–23.CrossRefPubMed
31.
go back to reference Diab M, Smith AR, Kuklo TR. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2007;32(24):2759–63.CrossRef Diab M, Smith AR, Kuklo TR. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2007;32(24):2759–63.CrossRef
32.
go back to reference Ledonio CG, Polly DW Jr, Vitale MG, Wang Q, Richards BS. Pediatric pedicle screws: comparative effectiveness and safety: a systematic literature review from the Scoliosis Research Society and the pediatric Orthopaedic Society of North America task force. J Bone Joint Surg Am. 2011;93(13):1227–34.CrossRefPubMed Ledonio CG, Polly DW Jr, Vitale MG, Wang Q, Richards BS. Pediatric pedicle screws: comparative effectiveness and safety: a systematic literature review from the Scoliosis Research Society and the pediatric Orthopaedic Society of North America task force. J Bone Joint Surg Am. 2011;93(13):1227–34.CrossRefPubMed
Metadata
Title
Comparison of low density and high density pedicle screw instrumentation in Lenke 1 adolescent idiopathic scoliosis
Authors
Mingkui Shen
Honghui Jiang
Ming Luo
Wengang Wang
Ning Li
Lulu Wang
Lei Xia
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1695-x

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